Online Learning User Registration

Please register the user's details below. Remember, all users must have a unique email address.

Please ensue you select the 'Action Pull Down Menu'  to indicate what you require to be done with each user record.  If you require additional registrations, just complete and submit an additional form.

Note: Changes to user records are limited to the number of user subscriptions held under the agreement over the 12 month agreement term. If user records are removed the related user data will be lost.

Administrator Details
Administrator receives user access privileges in addition to the user license allocation.

Title DR MISS MR MRS MS
First Name *	Last Name *
Email Address *	Pharmacy Name*
User Details
User 1	Select Action -- Please select -- Register Modify Remove
User 1 - Name	User 1 - Email
User 2	Select Action -- Please select -- Register Modify Delete
User 2 - Name	User 2 - Email
User 3	Select Action -- Please select -- Register Modify Remove
User 3 - Name	User 3 - Email
User 4	Select Action -- Please select -- Register Modify Remove
User 4 - Name	User 4 - Email
User 5	Select Action -- Please select -- Register Modify Remove
User 5 - Name	User 5 - Email
Enter Word Verification in box below *

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